Abstract Details

To evaluate a procedure alternative to re-graft in six eyes with decompensated penetrating keratoplasty (PK) with high-degree astigmatism (HA).

Setting:

Prospective study. All procedures were performed by the same surgeon (M.B.) at Private Hospital Villa Igea, Forlģ, Italy.

Methods:

Best spectacle-corrected visual acuity (BSCVA), refraction and corneal topography were assessed before and 1, 3, 6, and 12 months after 2-step surgery.
All eyes underwent a standardized procedure consisting of the following two-steps. First step = Descemet stripping automated endothelial keratoplasty (DSAEK), including: a. Removal of the PK endothelium; b. Microkeratome-assisted dissection of a donor graft then punched to a diameter of 9.0 mm; c. Delivery of the graft through a 3.2 mm clear-cornea nasal tunnel, 1.0 mm in length; air-tight suturing of all incisions. All sutures were removed 1 month after DASEK. Second step (after an additional month) = Relaxing incisions in the PK wound along the steep axis up to the stromal surface of the DSAEK graft.

Results:

In all eyes, 1 month after the second step, BSCVA improved from ?20/200 to ?20/30. Mean topographic astigmatism decreased from 7.91±1.94 diopters (D) to 1.33±1.32 D (p<0.0001). These values did not change substantially at later examination times. Endothelial cell loss 6 months after surgery averaged 35% from the preoperative value. No early or late complications were seen.

Conclusions:

In eyes with failed PK grafts and HA, a 2-step procedure including DSAEK and relaxing incisions allows recovery of excellent BSCVA in a time much shorter than that necessary after a renewed PK .

Financial Interest:

... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented